Identification of diverticular disease in Swedish healthcare registers: a validation study

Figures & data

Figure 1. Flow chart.

Table 1. Basic characteristics of 601 patients with a diagnosis of diverticular disease (K57.2–K57.9) in the Swedish Patient Register in the years 2002 and 2010: distribution according to sex, age, type of hospital, department, rate of surgery, rate of surgery with pathology report and examinate with computed tomography (CT).

	2002: Diagnosis K572–K579 (n = 288)		2010: Diagnosis K572–K579 (n = 313)
	n	% of the cohort	n	% of the cohort	Total	%
Sex
Women	194	67.4	199	63.6	393	65.4
Men	94	32.6	114	36.4	208	34.6
Age
<30 years	2	0.7	2	0.6	4	0.7
30–39 years	6	2.1	17	5.4	23	3.8
40–49 years	29	10.1	30	9.6	59	9.8
50–59 years	59	20.5	69	22.0	128	21.3
60–69 years	54	18.7	68	21.7	122	20.3
70–79 years	68	23.6	61	19.5	129	21.5
>80 years	70	24.3	66	21.1	136	22.6
Type of hospital
University or regional	101	35.1	115	36.7	216	35.9
Country	187	64.9	198	63.3	385	64.1
Type of department
Surgical	257	89.2	288	92.0	545	90.7
Medical	7	2.4	16	5.1	23	3.8
Other	24	8.3	9	2.9	33	5.5
Surgery	59	20.5	47	15.0	106	17.6
Surgery with pathology report	34	11.8	19	6.1	53	8.8
Examinate with CT	87	30.2	232	74.1	319	53

Table 2a. Distribution of complications or other manifestations of diverticular disease according to ICD 10 coding and findings during review of medical records by experienced surgeon.

The Swedish National Registry of Patients according to		Diagnosis after physician validation
ICD-10 code	n	No diverti-culosis or bleeding (n, %)	Diverti-culosis without diverti-culitis or bleeding (n, %)	Diverti-culitis without abscess or perforation (n, %)	Abscess (n, %)	Perfor-ation (n, %)	Stricture (n, %)	Fistula (n, %)	Obstruction (n, %)	Diverticular bleeding (n, %)
K572: Diverticular disease of large intestine with perforation and abscess	99	2	1	29	36	61	3	4	0	3
		(2%)	(1%)	(29.3%)	(36.4%)	(61.6%)	(3%)	(4%)	(0%)	(3%)
K573: Diverticular disease of large intestine without perforation or abscess	324	10	93	221	0	2	8	1	3	8
		(3.1%)	(28.7%)	(68.2%)	(0%)	(0.6%)	(2.5%)	(0.3%)	(0.9%)	(2.5%)
K574: Diverticular disease of both small and large intestine with perforation and abscess	22	3	4	2	3	4	2	2	0	0
		(13.6%)	(18.2%)	(9.1%)	(13.6%)	(18.2%)	(9.1%)	(9.1%)	(0%)	(0%)
K575: Diverticular disease of both small and large intestine without perforation or abscess perforation or abscess	22	1	10	3	2	1	0	0	0	0
		(4.5%)	(45.5%)	(13.6%)	(9.1%)	(4.5%)	(0%)	(0%)	(0%)	(0%)
K578: Diverticular disease of intestine, part unspecified, with perforation and abscess	31	1	0	3	7	11	0	0	0	1
		(3.2%)	(0%)	(9.7%)	(22.6%)	(35.5%)	(0%)	(0%)	(0%)	(3.2%)
K579: Diverticular disease of intestine, part unspecified, without perforation or abscess	103	4	26	56	1	0	3	2	0	3
		(3.9%)	(25.2%)	(54.4%)	(1%)	(0%)	(2.9%)	(1.9%)	(0%)	(2.9%)
Total K57: All (overall diverticular disease)	601	21	134	314	49	79	16	9	3	15
		(3.5%)	(22.3%)	(52.2%)	(8.2%)	(13.1%)	(2.7%)	(1.5%)	(0.5%)	(2.5%)

Table 2b. Distribution of findings of DD according to ICD 10 and diagnostic modality (colonoscopy, CT, colon x ray), clinical diagnosis, surgical findings, or pathology report after surgery.

The Swedish National Registry of Patients according to ICD-10 code	n	Examined by colonoscopy (n, %)	Examined by Computed Tomography (n, %)	Examined by x-ray of colon (n, %)	Clinical diagnosis (n, %)	Abdominal pain (n, %)	Surgical findings (n, %)	Pathology report from surgery available (n, %)
K572: Diverticular disease of large intestine with perforation and abscess	99	16	69	6	0	86	60	33
		(16.2%)	(69.7%)	(6.1%)	(0%)	(86.9%)	(60.6%)	(33.3%)
K573: Diverticular disease of large intestine without perforation or abscess	324	103	135	61	6	205	27	17
		(31.8%)	(41.7%)	(18.8%)	(1.9%)	(63.3%)	(8.3%)	(5.2%)
K574: Diverticular disease of both small and large intestine with perforation and abscess	22	2	5	0	0	4	4	4
		(9.1%)	(22.7%)	(0%)	(0%)	(18.2%)	(18.2%)	(18.2%)
K575: Diverticular disease of both small and large intestine without perforation or abscess	22	3	8	2	1	6	5	3
		(13.6%)	(36.4%)	(9.1%)	(4.5%)	(27.3%)	(22.7%)	(13.6%)
K578: Diverticular disease of intestine, part unspecified, with perforation and abscess	31	3	15	0	1	14	6	1
		(9.7%)	(48.4%)	(0%)	(3.2%)	(45.2%)	(19.4%)	(3.2%)
K579: Diverticular disease of intestine, part unspecified, without perforation or abscess	103	26	36	13	1	54	4	2
		(25.2%)	(35%)	(12.6%)	(1%)	(52.4%)	(3.9%)	(1.9%)
Totally	601	153
		(25.5%)
K57: All (overall diverticular disease)	569	153	268	82	9	369	106	60
		(26.9%)	(47.1%)	(14.4%)	(1.6%)	(64.9%)	(18.6%)	(10.5%)

Table 3. Positive Predictive values after validation of 601 patients with diagnos diverticular disease (K57.2–K57.9) in the Swedish Patient Register in the years 2002 and 2010.

											Positive predictivevalue (95% CI)
	ICD code in SNPR	ICD 3-digits coded correct	ICD 2-digits coded correct	Other diagnosis than K57.	ICD code in SNPR	ICD 3-digits coded correct	ICD 2-digits coded correct	Other diagnosis than K57	PPV K57	PPV K57	PPV	PPV	PPV
Diagnosis	2002				2010				2002	2010	2002	2010	Total
K572	46	32	43	3	53	48	53	0	0.93	1.00	0.70	0.91	0.81
									(0.82–0.99)	(0.93–0.1)	(0.54–0.82)	(0.79–0.97)	(0.72–0.88)
K573	156	135	144	12	168	157	165	3	0.92	0.98	0.87	0.93	0.90
									(0.87–0.96)	(0.95–0.10)	(0.80–0.91)	(0.89–0.97)	(0.86–0.93)
K574	11	5	9	2	11	5	10	1	0.82	0.91	0.45	0.45	0.45
									(0.48–0.98)	(0.59–0.10)	(0.17–0.77)	(0.17–0.77)	(0.24–0.68)
K575	17	13	17	0	5	4	4	1	1.00	0.80	0.76	0.80	0.77
									(0.81–0.10)	(0.28–0.10)	(0.50–0.93)	(0.28–0.10)	(0.55–0.92)
K578	12	5	10	2	19	13	18	1	0.83	0.95	0.42	0.68	0.58
									(0.52–0.98)	(0.74–0.10)	(0.15–0.72)	(0.43–0.87)	(0.39–0.75)
K579	46	36	40	6	57	50	56	1	0.87	0.98	0.78	0.88	0.83
									(0.74–0.95)	(0.91–0.10)	(0.64–0.89)	(0.76–0.95)	(0.75–0.90)
K57 ICD 2-digits coded			263				306				0.91	0.98	0.95
											(0.87–0.94)	(0.95–0.99)	(0.93–0.96)
Total ICD 3-digits coded	288	226			313	277			0.91	0.98	0.78	0.88	0.84
											(0.73–0.83)	(0.84–0.92)	(0.80–0.87)